Provider Demographics
NPI:1699785683
Name:STALNAKER, DERA LEIGH (PHARM D)
Entity type:Individual
Prefix:
First Name:DERA
Middle Name:LEIGH
Last Name:STALNAKER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BLUFF CITY HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37600
Mailing Address - Country:US
Mailing Address - Phone:423-764-4136
Mailing Address - Fax:423-764-5167
Practice Address - Street 1:310 BLUFF CITY HIGHWAY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37600
Practice Address - Country:US
Practice Address - Phone:423-764-4136
Practice Address - Fax:423-764-5167
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist